Urgent Care Clinic vs. Hospital Emergency Room – Costs & Comparison
A few years ago, our cat bit my husband while he was trying to give her a pill. He made the mistake of not seeing a doctor right away, and by the time his hand started to swell up, the doctor’s office was closed for the weekend. We knew it couldn’t wait until Monday, so we went to the emergency room, where it took us nearly five hours just to see a doctor and get a prescription for an antibiotic – which we then had to find an all-night pharmacy to fill. And on top of everything else, we had to pay a $100 copay to our insurance.
This trip to the ER was a big pain, but at the time, we figured we had no choice. In fact, we could have saved ourselves a lot of hassle by going to an urgent care center instead.
Urgent care centers are health care facilities that treat urgent but non-life-threatening problems. They don’t have as much equipment as a hospital ER, and they can’t admit you for long-term care if you need it. But for the problems they can treat, their service is usually much faster, and much cheaper. This makes them a great choice if you need affordable care without health insurance – or if you just have better things to do than spend half the night waiting to see a doctor.
Normally, when you have a health problem, you go to see your doctor. However, this isn’t always possible if you have an urgent problem that needs treatment right away, such as my husband’s cat bite. Most doctor’s offices are heavily booked, and they usually can’t give you a same-day appointment, even for an emergency. And on evenings and weekends, 73% of Americans say they have no access to their primary care doctors at all, according to Debt.org.
Urgent care centers were created in the 1990s to fill in this gap. Like emergency rooms, they’re open every day, and you don’t need an appointment to get care there. However, there are several major differences between an urgent care center and an ER, including:
According to a 2016 report from the Centers for Disease Control and Prevention (CDC), nearly one in five Americans visits a hospital ER each year. However, not all of them really need to. About 19% of all emergency room patients say they only went there because their doctor’s office was closed or because they had nowhere else to go for care.
These patients would probably be much better off receiving care from an urgent care center. They could get the care they need faster and at a much lower cost. They’d also face less risk of having their health insurance companies refuse to cover the cost.
The reason so many people use the emergency room for non-emergency care is that, by law, hospital ERs aren’t allowed to turn patients away – whether they can pay or not. As a result, many people who don’t have health insurance rely on the ER as their main source of health care. To make up for all these nonpaying patients, ERs charge higher rates to everyone else.
This makes the emergency room one of the most expensive place to get care. According to the health insurer Cigna, the average visit to a hospital ER costs $1,757. By contrast, the average visit to an urgent care center costs $153.
Here are some estimates from Medica, a health insurance company, of how the cost of treating specific illnesses in the ER compares to the cost of treating them in urgent care:
Emergency rooms are in the business of saving lives. To save as many people as possible, they always make a point of treating patients with life-threatening illnesses first. Anyone who goes there with a condition that isn’t life-threatening – like my husband with his bitten hand – can expect to wait a long time.
On top of that, many hospital ERs are severely overcrowded. That means even once you’re let into an examining room, you’re likely to spend a lot of time waiting to receive the care you need. A 2014 CDC report found that the average ER patient spends 30 minutes in the waiting room and over 90 minutes receiving treatment. Thus, if you go to the ER with a problem, you can expect to be there for more than two hours.
Urgent care centers, by contrast, see patients on a first-come, first-serve basis. The Urgent Care Association of America (UCAOA) reports that at most urgent care centers, the average wait time to receive care is less than 30 minutes. The total time most patients spend there, from start to finish, is under an hour.
Many hospital emergency rooms can’t dispense drugs on-site. An ER doctor can give you a prescription, but you have to go to a pharmacy to get it filled. As my husband discovered, that can be a big problem if you don’t get out of the ER until after 1am.
Urgent care centers, by contrast, can usually dispense drugs right on-site. If you walk in with an infection that requires antibiotics, you can walk out with a supply of them, instead of a prescription to have filled somewhere else.
Because emergency room care is so expensive, health insurers would rather see their patients get care anywhere else. Often, they refuse to cover the cost of an ER visit if it wasn’t a true emergency. If you go to the ER with a non-urgent problem like a sore throat or a sprained ankle, there’s a good chance your insurance plan will refuse to pay for the visit, sticking you with a bill for hundreds or even thousands of dollars.
Fortunately, these are the kinds of cases that urgent care centers can handle easily. If you take your sprained ankle to an urgent care center instead of the ER, your insurer will probably pay for the visit. Dr. Franz Ritucci, President of the American Academy of Urgent Care Medicine (AAUCM), says in an interview with Debt.org that about 70% of all visitors to urgent care centers use health insurance and have no cost but a copay. However, it’s still a good idea to call the urgent care center before you go and make sure it accepts your insurance.
Even if your insurer does cover the cost of an ER visit, you could still save money by going to an urgent care center. Insurers tend to charge extra-high copays for emergency room care – often $100 or more. By contrast, the copay for a trip to an urgent care center is likely to be a more reasonable $35 to $75.
Although urgent care centers are both faster and cheaper than the ER, they aren’t the best choice in every situation. Here are a few of the downsides of choosing an urgent care center rather than a hospital emergency room:
When you’re deciding where to go for medical care, there are two questions you should ask yourself. The first is, “Can it wait?” A trip to an urgent care center costs less than going to the ER, but more than seeing your regular doctor. If you have a medical problem that isn’t urgent – say, a minor sore throat or a backache – it’s better to wait for a doctor appointment.
The second question is, “Is it deadly?” Urgent care centers are cheaper and faster than emergency rooms, but they can’t handle life-threatening emergencies. If you have a problem that could kill you if it’s not treated right away, you need to head for the nearest ER. There, you’ll be moved straight to the front of the line, and you’ll also be able to get the care you need to stabilize you.
If the answer to both questions is no, that’s when an urgent care center – assuming there’s one that’s open – is your best choice. You’ll get in and out faster than you will at the ER, and you’ll probably pay less too, with or without insurance.
Here are some examples of urgent, but not deadly, problems that can be treated in an urgent care center:
Even if you know you should go to the emergency room for life-threatening problems, it’s not always easy to tell when your problem is life-threatening. Health insurers tend to rely on what they call the Prudent Layperson Standard.
According to this rule, if a “prudent layperson” – that is, a reasonable person who has no medical training – would believe that your health problem could be serious enough to threaten your life, or to cause permanent organ damage, then you should go to the ER. Even if the doctors there eventually conclude that your problem is something less serious, your insurance should still cover the cost of the visit.
Here are some examples of conditions that call for emergency medical care:
How to Find an Urgent Care Center
According to the UCAOA, there are nearly 7,400 urgent care centers in the United States. You can find them in stand-alone buildings, in strip malls and shopping centers, or attached to medical offices.
Many urgent care centers are part of large, nationwide chains. The biggest ones include:
One way to find an urgent care center near you is to search the websites of these large chains. You can also try the search tool on the AAUCM website, which lets you search by state or zip code. Another searchable site is UrgentCareLocations.com, where you can look for urgent care centers as well as other types of health care providers. This site can provide directions to a selected center and even sort the list to show you which sites are open.
One feature these search tools don’t include is information about which types of health insurance a given center accepts. The best way to find this information is to search the website of your health insurance provider. Some companies have search tools that let you locate nearby health care facilities that accept your plan. If yours doesn’t have this kind of tool, your best bet is to call nearby urgent care centers and ask them if they take your insurance.
It’s easy to see how choosing an urgent care center over an ER can benefit you. However, what might be less obvious is how it can benefit others. The truth is, when you choose to visit an urgent care center instead of an emergency room for non-emergency care, you’re also helping the health care system as a whole.
One of the many factors contributing to the rising cost of healthcare in this country is the number of people who rely on hospital emergency rooms as their main source of care. When people switch from ERs to less expensive urgent care centers, it helps lower the amount health insurers have to shell out for their care. This, in turn, reduces the amount the insurers have to charge for premiums in order to make a profit.
A 2010 study by the RAND Corporation found that if all non-emergency visits to ERs could be shifted to urgent care centers and retail clinics, it could save the country over $4 billion a year. Of course, that’s only a drop in the bucket compared to the $3 trillion the U.S. spends each year on health care costs – but it’s one small step towards fixing a big problem.
Have you ever visited an urgent care center? If so, would you recommend it?
Amy Livingston is a freelance writer who can actually answer yes to the question, “And from that you make a living?” She has written about personal finance and shopping strategies for a variety of publications, including ConsumerSearch.com, ShopSmart.com, and the Dollar Stretcher newsletter. She also maintains a personal blog, Ecofrugal Living, on ways to save money and live green at the same time.
Urgent Care Clinic vs. Hospital Emergency Room – Costs & Comparison
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